MEDICARE: MR. JAMES L. WIMS C.S.T./C.S.F.A/SA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist	105719	FL
2	246ZC0007X	Surgical Assistant	117931	FL

General Provider Information

NPI Number	:	1639313000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES L. WIMS C.S.T./C.S.F.A/SA-C

Provider Business Mailing Address
First Line	:	PO BOX 1830
Second Line	:	619 N.E. 7TH AVE.
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34423-1830
Country	:	US
Telephone Number	:	352-563-7032
Fax Number	:

Provider Business Practice Location Address
First Line	:	10495 N FLORIDA AVE
Second Line	:
City	:	CITRUS SPRINGS
State	:	FL
Zip	:	34434-3268
Country	:	US
Telephone Number	:	352-465-5663
Fax Number	:	352-465-5664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	08/30/2020

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Directions to “ MR. JAMES L. WIMS C.S.T./C.S.F.A/SA-C” Practice Location

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